1376852335 NPI number — MRS. ADELENE CHAN PRADO NP

Table of content: MRS. ADELENE CHAN PRADO NP (NPI 1376852335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376852335 NPI number — MRS. ADELENE CHAN PRADO NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRADO
Provider First Name:
ADELENE
Provider Middle Name:
CHAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAN
Provider Other First Name:
ADELENE
Provider Other Middle Name:
CRYSTAL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376852335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 DISTEL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALTOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94022-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
310-828-2382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 INDUSTRIAL RD FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN CARLOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-596-4030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  19956 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1376852335 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".